RECOGNITION OF A NURSING SPECIALTY, APPROVAL OF A SPECIALTY NURSING SCOPE OF PRACTICE STATEMENT, AND

RECOGNITION OF A NURSING SPECIALTY, APPROVAL OF A SPECIALTY NURSING SCOPE OF PRACTICE STATEMENT, AND ACKNOWLEDGMENT OF SPECIALTY NURSING STANDARDS OF PRACTICE Approved by Congress on Nursing Practice and Economics September 2005 1

Congress on Nursing Practice and Economics 2005-2007 Susan Tullai-McGuinness, MPA, PhD, RN, Chairperson Mary A. Maryland, PhD, APRN,BC, ANP, Vice Chairperson Esther Acree, MSN, RN, SpCl.NSG, BC-FNP Karen A. Ballard, MA, RN Bobbie Berkowitz, PhD, CNAA, FAAN Virginia Burggraf, DNS, RN, FAAN Emma L. Doherty, MA, RN Irmatrude Grant, MS, RN Maureen Ann Nalle, PhD, RN Ann Mabe Newman, DSN, APRN,BC Susan Foley Pierce, PhD, RN Tracy A. Ruegg, MS, CNP, RN, AOCN Lorna Samuels, MSN, ANP, GNP, RN, BC Jeanne Surdo, MA, BSN, RN Cathalene Teahan, MSN, CNS, RN, BC Susan A. Albrecht, PhD, RN, FAAN Organizational Affiliate Representative Dave Hanson, MSN, CNS, RN, CCRN Organizational Affiliate Representative Joanna Sikkema, MSN, ARNP Organizational Affiliate Representative Committee on Nursing Practice Standards and Guidelines 2005-2007 Kathleen M. White, PhD, RN, CNAA, Chairperson Lygia Lee Arcaro, MSN, MHA, RNC, Deborah Gatz, MN, APRN Brenda L. Lyon DNS, CNS, FAAN Margaret Nelson, MS, RN Ann O Sullivan, MSN, RN, CNA Barbara Russell, MPH, RN, CIC, ACRN Anne Wojner-Alexandrov, PhD, RN, CCRN ANA Staff Carol J. Bickford, PhD, RN,BC, Senior Policy Fellow Yvonne D. Humes, MSA, Senior Administrative Assistant Winifred Carson-Smith, JD, Nursing Practice Counsel With consultation from Nurse Competence in Aging Nurse Competence in Aging is a 5-year initiative funded by The Atlantic Philanthropies (USA) Inc., awarded to the American Nurses Association (ANA) through the American Nurses Foundation (ANF), and represents a strategic alliance between ANA, the American Nurses Credentialing Center (ANCC) and the John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing. Revised and Approved in September 2005 Originally developed in 1998 by the American Nurses Association Congress of Nursing Practice and the Committee on Nursing Practice Standards and Guidelines in collaboration with members of the ANA Nursing Organizations Liaison Forum (NOLF). Revised and approved by the Congress on Nursing Practice and Economics in September 2005. 2

Table of Contents Building Quality Nursing Practice...4 American Nurses Association...4 Foundational Resources for Nursing Practice...4 Other Building Blocks...4 History of ANA s Recognition Program for Specialty Practice...6 Process for Recognition of A Nursing Specialty, Approval of Scope Statements and/or Acknowledgment of Practice Standards...8 Inclusion of Gerontology Specific Content...11 Recognition As A Nursing Specialty...13 Criteria for Recognition As A Nursing Specialty...13 Approval of A Specialty Nursing Scope Statement...14 Criteria for Approval of A Specialty Nursing Scope Statement...14 Acknowledgment of Standards of Specialty Nursing Practice...16 Criteria for Acknowledgment of Specialty Nursing Standards...17 Summary...18 Glossary...19 References...21 Appendix A ANA Workgroups for Revision/Development of Specialty Nursing Scope of Practice Statements and Standards of Nursing Practice...22 3

BUILDING QUALITY NURSING PRACTICE AMERICAN NURSES ASSOCIATION The American Nurses Association (ANA) is the only full-service professional organization representing the nation's 2.7 million registered nurses through its 54 constituent member nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on healthcare issues affecting nurses and the public. The ANA in such a leadership role must address the assurance of quality in the clinical, administrative, education, and research domains of nursing practice. FOUNDATIONAL RESOURCES FOR NURSING PRACTICE Three documents establish the foundation and create the framework for all nursing practice within the global domains of practice, education, administration, and research, as well as in more discrete areas of specialty practice. Nursing s Social Policy Statement, Second Edition (ANA, 2003), describes professional nursing s accountability to the public and identifies the processes of self-regulation, professional regulation, and legal regulation as mechanisms to maintain that trust. A second resource, the Code of Ethics for Nurses With Interpretive Statements (ANA, 2001) provides significant guidance for all nurses and their nursing practice in every setting. The third foundational document, Nursing: Scope and Standards of Practice (2004) presents more detail in further defining the scope and standards of practice for all registered nurses, including the advanced practice registered nurse (APRN) and the nurse working in a role specialty. Nursing: Scope and Standards of Practice describes what nursing is, what nurses do, and those responsibilities for which nurses are accountable. The scope and standards of nursing practice are highly valued by practitioners nationally and internationally and are regularly referenced by those engaged in legal, regulatory, administrative, educational, and research activities. The scope and standards of nursing practice language serves also as a template for a nursing specialty when delineating the details and complexity of that specialty. OTHER BUILDING BLOCKS The applicable state nurse practice act and regulatory language, accompanied by the interpretation of those directives by the responsible legal and regulatory bodies, provide further guidance to the registered nurse in identifying the components of quality nursing practice. Similarly, institutional policies and procedures establish other parameters to consider when describing one s nursing practice. The registered nurse, after completing a thoughtful, personal self-assessment, will elect to choose from the many available options to define a prescribed and circumspect specialty practice. See Figure 1. 4

Figure 1. BUILDING SAFE, QUALITY, AND EVIDENCE-BASED NURSING PRACTICE Self Determination Quality Institutional Policies and Procedures Safety Nurse Practice Act and Rules and Regulation Nursing Professional Scope of Practice, Standards of Practice, Code of Ethics Evidence Description: The nursing profession is responsible to its members and to the public it serves to define the code of ethics, scope of practice, and standards of practice. Specialty nursing scope and standards of practice provide further details about a focused area of nursing practice. The scope of practice, standards of practice, and code of ethics serve as the foundation for legislation and regulatory policy-making, most often identified and formalized as the nurse practice act and applicable rules and regulations. Scopes of practice, standards of practice, nurse practice acts and rules and regulations provide guidance for the development of institutional policies and procedures. After completing a thoughtful, personal self-assessment of skills, knowledge, and abilities, the registered nurse will elect to choose from the many available options to define a prescribed and circumspect specialty practice. This professional decision includes consideration of how the scope of practice, standards of practice, code of ethics, nurse practice act, rules and regulations, and institutional policies and procedures establish the parameters of one s own practice. Outcome = safe, quality, and evidence-based practice 5

H ISTORY OF ANA S RECOGNITION PROGRAM FOR SPECIALTY PRACTICE As the ANA s organizational structure evolved and specialty practice interests expanded, increasing numbers of specialty nursing organizations emerged to provide pertinent specialty focused continuing education and professional resources. The specialty nursing organizations also created specialty practice standards and guidelines to describe a distinct focus of practice which in turn resulted in significant diversity in format and content. The rapidly changing healthcare environment s demands, including the call for certification of nurses for specialty practice, created the need to develop consistent, standardized processes for recognizing specialty areas of nursing practice, approving specialty nursing scope of practice statements, and acknowledging specialty nursing standards of practice. During the late 1990 s the ANA convened representatives from various specialty nursing groups to address the need for consistency in standards of practice and to identify a formal mechanism to confirm professional recognition of specialty practice. This resulted in the ANA Congress of Nursing Practice becoming the neutral reviewing body of specialty nursing standards of practice. The Congress of Nursing Practice established a standing committee to conduct that work under its oversight. The ANA continues to provide these services to the profession. The Congress on Nursing Practice and Economics (CNPE) has the designated oversight responsibility for developing and maintaining the scope and standards of practice. The CNPE s Committee on Nursing Practice Standards and Guidelines assists in this work. The members of this committee, with their special interest and expertise in practice and standards work, identify issues, serve as the first reviewers of specialty nursing organization scope and standards documents, make recommendations to the CNPE, provide consulting assistance, and coordinate and manage the ANA practice standards program under the direction of the CNPE. This committee also monitors the international nursing practice standards initiatives. The CNPE and the Committee on Nursing Practice Standards and Guidelines rely on the Code of Ethics for Nurses With Interpretive Statements (ANA, 2001), Nursing s Social Policy Statement, Second Edition (ANA, 2003), and Nursing: Scope and Standards of Practice (ANA, 2004) to inform their decisions. The Nursing: Scope and Standards of Practice serves as a template for a nursing specialty when describing the details and complexity of that practice. Because of the significant changes in the evolving healthcare and nursing practice environments, the Congress on Nursing Practice and Economics continue to reaffirm the earlier Congress of Nursing Practice decision that specialty nursing standards must be reviewed, revised as necessary, and resubmitted for acknowledgment at least every five years, or more frequently if warranted. Because the context of specialty practice should not be separated from the standards of practice, the Committee on Nursing Practice Standards and Guidelines requests that specialty nursing organizations forward the specialty scope of practice statement for review and approval with each standards revision. Completing the review process before publication will allow inclusion of the appropriate announcement about the ANA 6

approval or acknowledgment in the final document. The following sections provide specific details and guidance about the ANA s program for recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, and acknowledgment of specialty nursing standards of practice. 7

PROCESS FOR RECOGNITION OF A NURSING SPECIALTY, APPROVAL OF SCOPE STATEMENTS AND/OR ACKNOWLEDGMENT OF PRACTICE STANDARDS ANA is pleased to assist specialty nursing organizations as they explore their interest in recognition of a nursing specialty, complete their assessment of readiness to be formally recognized as a specialty practice, or pursue approval of a scope of practice statement and acknowledgment of specialty practice standards. The development of specialty nursing scope and standards normally takes from 18 to 24 months. Interested nursing groups can expect that the review and pre-publication processes include some or all of these activities: 1. The interested specialty nursing organization (or collaborating specialty nursing organizations) contacts ANA to express its interest in gaining formal recognition of a nursing specialty, approval of a scope statement, and/or acknowledgment of specialty practice standards. 2. Upon being notified of a specialty nursing organization or group s interest in requesting recognition of a specialty, approval of a scope statement, and/or standards acknowledgment, ANA sends a complimentary copy of Nursing: Scope and Standards of Practice (ANA, 2004) and other materials explaining the process and criteria for recognition, approval, and acknowledgment to the contact person. 3. The nursing organization or group of organizations establishes a workgroup or taskforce to create the new or revised specialty nursing scope and standards of practice. The model used by ANA for selection of workgroup or taskforce members in Appendix A may be a helpful resource. 4. The nursing organization develops the specialty scope and standards document. This process should include opportunities for member input and public comment, as well as a defined leadership team or board of directors approval mechanism. 5. The nursing organization submits the specialty scope and standards document, preferably unpublished documents, for ANA review. 6. The ANA Committee on Nursing Practice Standards and Guidelines reviews the submission against established review criteria that have been approved by the Congress on Nursing Practice and Economics. (See pages 13-18) 7. When the submission meets the established review criteria, the Committee on Nursing Practice Standards and Guidelines forwards the recommendations to the Congress on Nursing Practice and Economics for recognition, approval, and acknowledgment. 8

8. The Committee provides written recommendations to the specialty group if the document does not meet the established review criteria. The Committee members and designated ANA support staff are available to assist the specialty group in resolving discrepancies in content and format in preparation for re-submission for a second review. 9. The Congress on Nursing Practice and Economics recognizes the area of nursing practice as a specialty, approves the scope statement, and/or acknowledges the standards OR returns the document(s) to the Committee identifying the unmet criteria and requesting additional information or changes in the document(s) followed by re-submission from the specialty nursing organization. 10. ANA s publishing arm, nursesbooks.org, provides free editorial, publishing, and marketing services for specialty nursing organizations wishing to maximize dissemination of those specialty scope and standards of practice that have completed the ANA review process. Nursesbooks.org currently markets a special package that includes all currently published specialty scope and standards of practice. On the rare occasion when the specialty nursing organization elects to self-publish the specialty nursing scope and standards that have met the review criteria, the CNPE will provide a specific approval and acknowledgment statement that should be included in that publication. 11. Specialty nursing scope and standards documents should be reviewed and revised as necessary at least every five years, or more frequently if changes in the practice environment dictate. Occasionally the specialty scope and standards are retired. 12. The ANA may convene a workgroup of experts to develop or revise the scope and standards of practice in select instances. See Appendix A ANA Workgroups for Revision/Development of Specialty Nursing Scope of Practice Statements and Standards of Specialty Nursing Practice for selection criteria for workgroup members. The ANA development/revision process includes a posting of the draft document for a 6-week public comment period at www.nursingworld.org and may also incorporate discussion forums at appropriate professional meetings, conferences, and conventions. The resultant scope and standards are submitted for the usual ANA review process. See Figure 2 for an overview of the process for recognition of a nursing specialty, approval of specialty nursing scope statements and/or acknowledgment of specialty nursing practice standards. 9

FIGURE 2. PROCESS FOR RECOGNITION OF A NURSING SPECIALTY, APPROVAL OF SPECIALTY NURSING SCOPE STATEMENTS AND/OR ACKNOWLEDGMENT OF SPECIALTY NURSING PRACTICE STANDARDS Revision Recommended Revision Recommended Specialty Nursing Organization (SNO) requests information packet from ANA SNO develops specialty scope and standards SNO seeks membership input, public comment, and leadership approval SNO submits prepublication scope and standards to ANA review process ANA s Committee on Nursing Practice Standards & Guidelines evaluates scope and standards against established review criteria Congress on Nursing Practice & Economics (CNPE) reviews document and recognizes specialty, approves scope statement and/or acknowledges standards SNO is notified of CNPE s decision Please contact ANA staff via telephone at 301.628.5060 or 301.628.5070 to discuss the various steps in the submission and review process, answer any questions, and provide assistance and necessary materials. 10

INCLUSION OF GERONTOLOGY SPECIFIC CONTENT In 2002, with funding from Atlantic Philanthropies, Inc, the ANA initiated the Nurse Competence in Aging (NCA) program. NCA recognizes that care of older adults is the core business of the nation s hospitals, home care and nursing homes, and underscores ANA s commitment to assure geriatric competence among the nation s practicing nurses. In 2003, the ANA Congress on Nursing Practice and Economics issued a statement that called for all professional nursing associations developing new or revising an existing specialty scope and standards document to address care issues related to older adults. Nursing specialties seeking to comply with this ANA directive would identify the importance of care of the older adult within the specialty nursing scope of practice statement. Where applicable, language could appropriately indicate that the specialty acknowledges and embraces the fact that older adults represent either the primary or predominant population served, or a unique population served by the specialty. For example: Because diseases (conditions) increase dramatically and/or destabilize with age, older adults constitute a focus of (specialty s name) nursing care. The management of older adults with this/these diseases and/or conditions requires special skills and knowledge. The Scope of Practice section could cite statistics as to the percentage of older adults served by the specialty. For example: xx% of the patients served by (specialty s name) nurses are older adults and their families. (specialty s name) nursing care is provided to patients of all ages across the continuum of care from acute care to community care, recognizing that older adults form the predominant or unique patient group. xx% of all patients with (disease, cared for on units, etc) are older adults. Good sources for these data include: Nurse Competence in Aging website: www.geronurseonline.org NCUP Nationwide Inpatient Sample (NIS), Agency for Health Research and Quality (AHRQ) http://hcup.ahrq.gov/hcupnet.asp The Hartford Center of Geriatric Nursing Excellence (HCGNE) at the University of Pennsylvania: www.nursing.upenn.edu/centers/hcgne The Hartford Center of Geriatric Nursing Excellence (HCGNE) at University of Iowa College of Nursing: http://www.nursing.uiowa.edu/hartford/ 11

The John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing: www.hartfordign.org Inclusion of specific content addressing the assessment, diagnosis, planning, outcomes identification, and evaluation that focuses on the older adult can be most easily accommodated in the language of the measurement criteria for the standards of practice. Similarly, opportunities exist to include consideration of the complexity of care for older adults and their families and/or caregivers exist within the measurement criteria for specialty nursing standards of professional performance. Consultation services from the Nurse Competence in Aging initiative can provide further assistance to those specialty nursing organizations wishing to develop more specific scope and standards of practice language. STATISTICS RELATED TO GERIATRIC NURSING Currently Much of All Health Care Is Devoted to Care of Older Adults: 57% of all visits to generalist physicians 50% of hospital expenditures 80% of home care visits 90% of nursing home care Older Adults Are a Hospital s CORE Business: Make up 52% of non-obstetric hospital days Longer lengths of stay (7.8 days vs. 5.4 days) Higher rates of re-admission within 30 days Documented functional declines & medical errors Older Adults make up: 60% of medical-surgical patients 46% of CCU patients 50% of ICU days 60% of all visits to cardiologists 63% of visits to oncologists In ERs, 26% of hospital admissions after trauma 12

RECOGNITION AS A NURSING SPECIALTY The process of recognizing an area of practice as a nursing specialty allows the profession to formally identify subset areas of focused practice. A clear description of that specialty nursing practice assists the larger community of nurses, healthcare consumers, and others to gain familiarity and understanding of the nursing specialty. Therefore, the document requesting ANA recognition must clearly and fully address each of the fourteen specialty recognition criteria. The CNPE requests that a contemporary specialty nursing scope of practice statement and standards of specialty nursing practice also accompany the request for recognition. Other supporting documents and references may be included to provide additional information, but are not required. CRITERIA FOR RECOGNITION AS A NURSING SPECIALTY The recognition criteria were originally developed in 1998 by the American Nurses Association Congress of Nursing Practice and its Committee on Nursing Practice Standards and Guidelines in collaboration with members of the Nursing Organization Liaison Forum (NOLF). The Congress on Nursing Practice and Economics regularly reviews the adequacy of the criteria, completed a minor revision in 2004, and continues to use the criteria during the review and decision-making processes to recognize an area of practice as a nursing specialty. A nursing specialty: 1. Defines itself as nursing. 2. Adheres to the overall licensure requirements of the profession. 3. Subscribes to the overall purposes and functions of nursing. 4. Is clearly defined. 5. Is practiced nationally or internationally. 6. Includes a substantial number of nurses who devote most of their practice to the specialty. 7. Can identify a need and demand for itself. 8. Has a well derived knowledge base particular to the practice of the nursing specialty. 9. Is concerned with phenomena of the discipline of nursing. 10. Defines competencies for the area of specialty nursing practice. 11. Has existing mechanisms for supporting, reviewing and disseminating research to support its knowledge base. 12. Has defined educational criteria for specialty preparation or graduate degree. 13. Has continuing education programs or continuing competence mechanisms for nurses in the specialty. 14. Is organized and represented by a national specialty association or branch of a parent organization. 13

APPROVAL OF A SPECIALTY NURSING SCOPE STATEMENT Nursing s Social Policy Statement, 2 nd Edition, identifies that Professional nursing has one scope of practice, which encompasses the range of activities from those of the beginning registered nurse through the advanced level (ANA. 2003, p. 8). A scope of practice statement describes the who, what, where, when, why, and how of nursing practice. Specialization involves focusing on a part of the whole field of professional nursing. The American Nurses Association and specialty nursing organizations delineate the components of rofessional nursing practice that are essential for any particular specialty (ANA, 2003). The development of a specialty nursing scope of practice statement provides an opportunity to describe what the practice of the registered nurse entails and to claim an area of nursing practice as a specialty. For approval of the specialty nursing scope statement, the organization s written submission must address all of the following criteria. Should the area of practice not meet one of the criteria, an explanation of why the criterion is not applicable or cannot be met must be included. CRITERIA FOR APPROVAL OF A SPECIALTY NURSING SCOPE STATEMENT The specialty nursing scope of practice: 1. Includes a definition of the nursing specialty that discusses the parameters for the specialty nursing practice, practice characteristics, and phenomena of practice. 2. Describes the practice environment in sufficient detail to establish an understanding of the specialty practice settings. 3. Clearly establishes who the practitioners are in the nursing specialty. 4. Describes the historical perspective of the development of the nursing specialty. 5. Discusses the current issues and trends in health care affecting the nursing specialty. 6. Differentiates generalist and advanced practice registered nurse roles. 7. Addresses the educational preparation of the nurse for both generalist and advanced levels. 8. Addresses the mandate for continuing professional development and lifelong learning. 9. Addresses the presences or absence of specialty practice certification opportunities. 14

10. Incorporates language congruent with Nursing s Social Policy Statement, 2 nd Edition (ANA, 2003). 11. Demonstrates congruence with the Code of Ethics For Nurses With Interpretive Statements (ANA, 2001). 12. Includes language congruent with Nursing: Scope and Standards of Practice (ANA, 2004). 15

ACKNOWLEDGMENT OF STANDARDS OF SPECIALTY NURSING PRACTICE Nursing: Scope and Standards of Practice identifies standards of practice as authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. Consequently, standards reflect the values and priorities of the profession. Standards provide direction for professional nursing practice and a framework for the evaluation of this practice. Written in measurable terms, standards also define the nursing profession s accountability to the public and the outcomes for which registered nurses are responsible (ANA, 2004, p. 3). The standards language from Nursing: Scope and Standards of Practice provides a framework for further describing the specialty nursing practice for the registered nurse, the advanced practice registered nurse (APRN), and the registered nurse in the role specialty. In fact, the ANA s Committee on Nursing Practice Standards and Guidelines and Congress on Nursing Practice and Economics expect the specialty nursing organization will have adapted the Standards of Nursing Practice template content and format and its components of Standards of Practice and Standards of Professional Performance to best express the specialty practice expectations. For example, this framework could be presented as: Standards of (Specialty) Nursing Practice Standards of Practice 1 Assessment 2 Diagnosis 3 Outcomes Identification 4 Planning 5 Implementation Coordination of Care Health Teaching and Health Promotion Consultation Prescriptive Authority 6 Evaluation Standards of Professional Practice 7 Quality of Practice 8 Education 9 Professional Practice Evaluation 10 Collegiality 11 Collaboration 12 Ethics 13 Research 14 Resource Utilization 15 Leadership 16

The six Standards of Practice describe a competent level of nursing care as demonstrated by the nursing process. The nine Standards of Professional Performance describe a competent level of behavior in the professional role including activities related to quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Every registered nurse is expected to meet each accompanying measurement criteria Every specialty nursing organization must address the standards of specialty nursing practice and measurement criteria for registered nurses and should include the applicable additional measurement criteria and standards for the APRN. If the specialty nursing practice best reflects a role specialty practice, such as administration, professional development, informatics, or other role specialty, the additional role specialty measurement criteria rather than the APRN content must accompany the registered nurse level standards and measurement criteria. CRITERIA FOR ACKNOWLEDGMENT OF SPECIALTY NURSING STANDARDS The following criteria must be met for the specialty nursing standards to be acknowledged: A. Standards of Practice Review Criteria 1. The six standards of practice with minor modifications reflect the nursing process. The specialty name is added but the essence of the core statement is unchanged. 2. The standards of practice address the following themes: Maintaining a safe environment Providing age-appropriate and culturally and ethnically sensitive care Educating patients about health practices and treatment modalities Assuring continuity of care Coordinating the care across settings and among care givers Managing information Communicating effectively Utilizing technology 3. The standards of practice for the registered nurse are standards of basic competency. 4. The standards of practice for the advanced practice registered nurse are standards of basic competency. 5. The standards of practice for the registered nurse in a role specialty are standards of basic competency. 6. Each measurement criterion: Is specific to the standard Is measurable 17

Is a measure of basic performance Has one action per measure B. Standards of Professional Performance Review Criteria 1. Standards of professional performance for the registered nurse are standards of basic competency. 2. Standards of professional performance for the APRN are standards of basic competency. 3. Standards of professional performance for the role specialist are standards of basic competency. 4. The nine standards of professional performance describe a competent level of behavior in the professional role. The specialty name is added, for example, but the essence of the core statement is unchanged. 5. Each measurement criterion for the specialty nursing performance standard: Is specific to the standard Is measurable Is a measure of basic performance Has one action per measure 6. There is consistency between the standards of practice and the standards of professional performance. C. Additional Review Criteria 1. If any standard or measurement criterion is not applicable and has been deleted, the specialty nursing organization includes an explanation in an accompanying statement. 2. If additional standards and measurement criteria are included, the specialty nursing organization includes an explanation about evolving practice and the need for the additional content in an accompanying statement. 18

SUMMARY The profession of nursing is changing in conjunction with patient needs and desires, expanding healthcare and nursing knowledge, and the evolution of healthcare delivery sites, systems, and technologies. As nurses focus their practice in new and different areas of patient care, clear statements of the scope of specialty nursing practice and standards of specialty practice and professional performance help assure continued understanding and recognition of nursing s diverse professional contributions. For further information, please contact the ANA s Department of Nursing Practice and Policy staff via telephone at 301.628.5060 or 301.628.5070. 19

GLOSSARY Advanced Practice Registered Nurse A registered nurse who has acquired advanced specialized clinical knowledge and skills to provide health care. These nurses are expected to hold a master s or doctorate degree. They build on the practice of registered nurses by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and significant role autonomy. (Nursing: Scope and Standards of Practice, 2004, p. 14) Assessment A systematic, dynamic process by which the nurse, through interaction with the client, significant others, and health care practitioners, collects and analyzes data about the client. Data may be collected on the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, functional abilities, developmental, economic, and life-style. Certification The formal recognition of the specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes. (American Board of Nursing Specialties, accessed on September 1, 2005 at http://www.nursingcertification.org/ ) Collaboration An interactive process whereby nurses and other health care professionals within an organization and/or the larger community work together, within their respective scopes of practice, for the benefit of the patient. Health care providers who successfully collaborate demonstrate a shared philosophy of care for the patient and mutual respect for each other and each role/discipline. Continuing Competence Ongoing professional nursing competence according to the level of expertise, responsibility, and domains of practice as evidenced by behavior based on beliefs, attitudes, and knowledge matched to and in the context of a set of expected outcomes as defined by nursing scope of practice, policy, code of ethics, standards, guidelines, and benchmarks that ensure safe performance of professional activities. (Scope and Standards of Practice for Nursing Professional Development, 2000, p. 3) Expected outcomes End results that are measurable, desirable, and observable, and translate into observable behaviors. (Nursing: Scope and Standards of Practice, 2004, p. 47) Implementation Ensuring practical fulfillment of goals by specific measures, including any or all of these activities: intervening, delegating, coordinating. The patient, significant others, or health care practitioners may be designated to implement interventions within the plan of care. Nurse Individual who is licensed by a state agency to practice as a registered nurse. 20

Nursing The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. (Nursing s Social Policy Statement, 2003, p. 6) Nursing Role Specialty Advanced levels of nursing practice that intersect with another body of knowledge, have a direct influence on nursing practice, and support the delivery of direct care rendered to patients by other professional nurses. (Nursing: Scope and Standards of Practice, 2004, p. 16) Patient Recipient of nursing practice. Other synonyms may include client, individual, resident, family, groups, communities, or populations. (Nursing: Scope and Standards of Practice, 2004, p. 49) Plan of care Comprehensive outline of care to be delivered to attain expected outcomes. It can include prescriptive plans of all disciplines involved with the patient s care. Standards of Practice Authoritative statements that describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. The nursing process encompasses all significant actions taken by registered nurses, and forms the foundation of the nurse s decision-making. (Nursing: Scope and Standards of Practice, 2004, p. 4) Standards of Professional Performance Authoritative statements that describe a competent level of behavior in the professional role, including activities related to quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. (Nursing: Scope and Standards of Practice, 2004, p. 4) 21

References American Board of Nursing Specialties, accessed on September 1, 2005 at http://www.nursingcerticiation.org/). American Nurses Association. (2004). Nursing: Scope and Standards of Practice. Washington, DC: nursesbooks.org. American Nurses Association. (2003). Nursing s Social Policy Statement, Second Edition. Washington, DC: nursesbooks.org. American Nurses Association. (2001). Code of Ethics for Nursing with Interpretive Statements. Washington, DC: American Nurses Publishing. American Nurses Association. (2000). Scope and Standards of Practice for Nursing Professional Development. Washington, DC: American Nurses Publishing. 22

APPENDIX A ANA WORKGROUPS FOR REVISION/DEVELOPMENT OF SPECIALTY NURSING SCOPE OF PRACTICE STATEMENTS AND STANDARDS OF NURSING PRACTICE FORMATION OF ANA WORKGROUP ANA initiates a workgroup of at least 6-9 individuals and supports its activities to complete the specialty nursing scope and standards development or revision activities. ANA uses designated criteria for selection of the workgroup members. The availability of telecommunications technologies and the practice of posting draft scopes and standards documents to www.nursingworld.org website permit extensive field reviews and comments as part of the process. COMPOSITION OF EACH SCOPE AND STANDARDS WORKGROUP Each Scope and Standards Workgroup has members who: Represent practice, education and administration areas Represent registered nurse and APRN roles as appropriate to specialty practice Have at least 5 years specialty practice experience Represent designated care settings as appropriate to the specialty practice ANA will always identify a designated representative from the Office of General Counsel as a seated workgroup member for the duration of the work. Other ANA staff may be invited to participate as necessary. CHARACTERISTICS OF INDIVIDUAL WORKGROUP MEMBERS Each workgroup member is a registered nurse who: Is recognized as a content expert in the practice area for which the scope and standards are being developed or reviewed* Is currently actively practicing in the specialty area under discussion* Has an understanding of the broad scope of nursing and specialty practice and a vision for the desired future state Is expected to have an appreciation of the historical perspective *Required Critical thinking and visioning are essential for success of the workgroup. Members are expected to represent various schools of thought. Stakeholder specialty organization representatives are expected to be endorsed by and designated to speak for the specialty organization. Distribution of members by educational preparation, gender, ethnicity, geographic representation is considered. 23